How many shoppable procedure prices are published for UPMC Kane?

UPMC Kane in Kane, PA currently has 97 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do UPMC Kane's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, UPMC Kane's median negotiated commercial rate is 1.2× the regionally adjusted fair BaseRate benchmark.

Hospital Profile Critical Access Hospital Voluntary non-profit - Private Updated: 3/6/2026

UPMC Kane

4372 Route 6, Kane, PA 16735 · 97 Priced Procedures

CMS Overall Rating No CMS Rating

Above Fair Market · Negotiate

1.22×vs. Fair Market Price

Typical commercial prices here are +22% above the fair benchmark (1.22×) even after accounting for local nurse/doctor wages and patient complexity.

78/100 · Corroborated

78/100Self-Pay Cash Beats Insurance 52% of the Time

File Completeness56

Price Logic82

Peer Alignment65

Clean Billing88

Real Cash Discount100

Premium Quality Tier

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Behavioral Pricing FingerprintHigh Insurer Rate · Deep Cash Discount

Cash-Arbitrage Bifurcated Pricer

UPMC Kane maintains elevated commercial insurance contracts (1.22× Fair BaseRate) while offering direct self-pay cash discounts that beat commercial negotiated medians on 52% of procedures. High-deductible and uninsured patients should always request the self-pay cash rate prior to billing.

#103 of 134 in PA · 76th State Percentile#2,068 of 3,385 in U.S. · 61st National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 0.74× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 52% of shoppable procedures (99/100 Cash Honesty)
CMS clinical safety score (85/100 safety score) with 72% patient recommendation
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (38.5% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 1.6× markup over Medicare rates
Captive ER (1.9×) & laboratory (3.0×) services average 1.23× higher multiples than routine shoppable care (1.3×)
Upper-quartile procedures (Q75 1.54×) jump +31% above the median procedure ratio (Q50 1.18×)
Unnegotiated chargemaster list prices average 8.8× Medicare (18¢ true HCRIS cost per $1 gross)

Front-Door ShoppableElective / Imaging

1.3× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER1.23× Divergence

1.6× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+31% Upper Tail

Q25 0.74× · Q50 1.18× · Q75 1.54×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.

Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×

Front-Door Shoppable CareFront-Door Shoppable

1.3× MedicareGood

Outpatient Surgery & ORBack-Door Captive

1.6× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

1.0× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

1.9× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

3.0× MedicareFair

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

2.3× MedicareFair

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

52% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

3 CMS · 85/100Good

Procedure Prices at UPMC Kane

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 97 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Spinal fusion, single level (inpatient stay) MS-DRG Code: `451`	—	$33,369	$30,775	1.1×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$26,897	$17,936	1.5×
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$22,440	$19,087	1.2×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$17,725	$19,432	0.9×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$8,485	$8,223	1.0×
Total knee replacement CPT Code: `27447`	—	$6,479	$13,523	0.5×
Total hip replacement CPT Code: `27130`	—	$5,415	$13,413	0.4×
Bunion correction surgery CPT Code: `28296`	—	$3,157	$3,446	unverified
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$1,862	$3,372	0.6×
Colonoscopy with biopsy CPT Code: `45380`	$1,399	$841	$1,256	0.7×
Blood transfusion CPT Code: `36430`	$791	$791	$498	1.6×
MRI, knee or other leg joint CPT Code: `73721`	$2,182	$734	$369	2.0×
MRI, brain (with and without contrast) CPT Code: `70553`	$1,605	$747	$511	1.5×
Colonoscopy (diagnostic) CPT Code: `45378`	$746	$729	$981	0.7×
Upper endoscopy with biopsy CPT Code: `43239`	$1,346	$730	$987	0.7×
MRI, brain (no contrast) CPT Code: `70551`	$1,203	$547	$343	1.6×
MRI, lower back (no contrast) CPT Code: `72148`	$1,250	$482	$338	1.4×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$739	$475	$448	1.1×
CT scan, head (with and without contrast) CPT Code: `70470`	$681	$381	$258	1.5×
CT scan, sinuses CPT Code: `70486`	$487	$300	$166	1.8×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$568	$295	$168	1.8×
CT scan, head (with contrast) CPT Code: `70460`	$551	$318	$242	1.3×
CT scan, chest (no contrast) CPT Code: `71250`	$568	$291	$167	1.7×
CT scan, neck (cervical spine) CPT Code: `72125`	$568	$293	$169	1.7×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$793	$301	$272	1.1×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$477	$304	$303	1.0×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$1,049	$318	$583	0.5×
CT scan, pelvis CPT Code: `72192`	$559	$273	$163	1.7×
Rabies immune globulin HCPCS Code: `90375`	$2,894	$280	$322	0.9×
Ultrasound, abdomen (complete) CPT Code: `76700`	$478	$218	$134	1.6×
CT scan, head (no contrast) CPT Code: `70450`	$260	$242	$160	1.5×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$239	$212	$148	1.4×
Ultrasound, pelvis CPT Code: `76856`	$227	$176	$130	1.4×
X-ray, hip CPT Code: `73502`	$190	$149	$93	1.6×
Screening mammogram (both breasts) CPT Code: `77067`	$116	$171	$123	1.4×
Ultrasound, thyroid and neck CPT Code: `76536`	$185	$162	$132	1.2×
Ultrasound, abdomen (limited) CPT Code: `76705`	$171	$153	$126	1.2×
X-ray, hand CPT Code: `73130`	$105	$117	$93	1.3×
X-ray, ankle CPT Code: `73610`	$128	$117	$93	1.3×
X-ray, foot CPT Code: `73630`	$121	$108	$92	1.2×
X-ray, shoulder CPT Code: `73030`	$105	$105	$92	1.1×
X-ray, lower back CPT Code: `72110`	$173	$90	$112	0.8×
Typhoid vaccine HCPCS Code: `90675`	$746	$314	$347	0.9×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	$244	$244	$203	1.2×
Pneumococcal vaccine HCPCS Code: `90732`	$183	$133	$140	0.9×
Electrical stimulation therapy HCPCS Code: `G0283`	$91	$57	$14	4.1×
Blood test, vitamin D CPT Code: `82306`	$160	$61	$31	2.0×
X-ray, neck (cervical spine) CPT Code: `72040`	$80	$62	$93	0.7×
New patient office visit (30-44 min) CPT Code: `99203`	$103	$73	$110	0.7×
Orthotic fitting and training CPT Code: `97760`	$79	$79	$51	unverified
Office visit, established patient (20-29 min) CPT Code: `99213`	$62	$50	$87	0.6×
Office visit, established patient (30-39 min) CPT Code: `99214`	$103	$70	$123	0.6×
X-ray, pelvis CPT Code: `72170`	$84	$48	$110	0.4×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$68	$68	$20	unverified
Blood test, calcium CPT Code: `82310`	$28	$11	$5	2.2×
Culture, blood CPT Code: `87040`	$56	$21	$11	1.9×
Blood test, PSA (prostate screen) CPT Code: `84153`	$70	$36	$19	1.9×
Blood test, basic metabolic panel CPT Code: `80048`	$132	$14	$9	1.6×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$170	$17	$11	1.5×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$95	$21	$14	1.5×
Physical therapy (manual therapy) CPT Code: `97140`	$104	$36	$34	1.1×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$197	$40	$56	0.7×
Speech therapy (language evaluation) CPT Code: `92507`	$70	$37	$86	0.4×
X-ray, chest (two views) CPT Code: `71046`	$213	$39	$93	0.4×
Blood test, creatinine (kidney) CPT Code: `82565`	$46	$10	$5	2.0×
Blood test, sodium CPT Code: `84295`	$56	$10	$5	2.0×
Blood test, thyroid (TSH) CPT Code: `84443`	$104	$34	$18	1.9×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$54	$8	$4	2.0×
Hepatitis C antibody test CPT Code: `86803`	$75	$28	$15	1.9×
Blood test, clotting time (PTT) CPT Code: `85730`	$41	$11	$6	1.8×
Blood test, potassium CPT Code: `84132`	$46	$9	$5	1.8×
Blood test, liver function panel CPT Code: `80076`	$121	$13	$9	1.4×
Hepatitis B vaccine HCPCS Code: `90744`	$141	$32	$37	0.9×
Breathing treatment (nebulizer) CPT Code: `94640`	$144	$45	$201	0.2×
Blood test, hemoglobin CPT Code: `85018`	$31	$5	$3	1.7×
Blood test, magnesium CPT Code: `83735`	$46	$11	$7	1.6×
Blood test, glucose (blood sugar) CPT Code: `82947`	$53	$6	$4	1.5×
Blood test, ferritin (iron stores) CPT Code: `82728`	$134	$19	$14	1.4×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$76	$4	$3	1.3×
Blood test, vitamin B12 CPT Code: `82607`	$79	$20	$16	1.3×
Culture, bacterial CPT Code: `87070`	$91	$11	$9	1.2×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$41	$6	$5	1.2×
Blood test, amylase CPT Code: `82150`	$108	$8	$7	1.1×
Blood test, lipase CPT Code: `83690`	$37	$8	$7	1.1×
Blood test, complete blood count (CBC) CPT Code: `85025`	$79	$9	$8	1.1×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$128	$11	$10	1.1×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$70	$29	$38	0.8×
Physical therapy (functional capacity test) CPT Code: `97750`	$70	$29	$38	0.8×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$78	$22	$40	0.6×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$76	$17	$39	0.4×
Physical therapy (gait training) CPT Code: `97116`	$82	$14	$33	0.4×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$78	$14	$35	0.4×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$102	$22	$64	0.3×
X-ray, chest (single view) CPT Code: `71045`	$163	$26	$92	0.3×
Blood antibody screen CPT Code: `86850`	$229	$13	$46	0.3×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$232	$17	$111	0.2×
Hospital observation (per hour) HCPCS Code: `G0378`	$32	$32	$86	unverified

Showing top 25 high-impact procedures of 97 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 38.5%

Audit a Bill or Quote at UPMC Kane (Zero PHI Required)

CMS CCN: 391318

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash Request Quote

Insurer Median $33,369

1. Amount on Your Bill or Quote ($) Pre-filled with UPMC Kane’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $30,809 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $30,809

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (38.5% of gross = $30,809).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask UPMC Kane's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$49,311 Above Fair BaseRate

Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)

Your bill ($80,086) is $49,311 above the denoised Fair BaseRate ($30,775) and 3.4× the $23,504 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.

IRS Form 990 Schedule H & 26 U.S.C. § 501(r) 501(c)(3) Nonprofit Hospital

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

Free Care Eligibility BenchmarkUp to 200% FPL100% charity write-off income threshold

Discounted Care EligibilityUp to 400% FPLSliding-scale & AGB billing cap tier

Charity Care Share of ExpensesSee Schedule HNet community financial assistance reported

26 U.S.C. § 501(r)(5) AGB Benchmark Method: lookback_commercial_median

Hospital-Specific CMS HCRIS Benchmark (38.5% of gross charges)

Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑

CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

Safety Composite85/100

Median ER Wait95 min

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at UPMC Kane. Prior administrative notices do not necessarily reflect current compliance status.

2025-03-25·administrative_or_closure
Closure Notice
Recorded
2025-02-11·warning_notice
Warning Notice
Recorded

Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Higher-Quality, Above-Median Price Tier

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for UPMC Kane.

Price Index: 1.44× regional baseline

Quality: 54/100 CMS composite

Median Household Income$58,496U.S. Census ACS

Local Uninsured Share3.2%Regional ACS estimate

200% FPL (1 Person)$31,920Common free-care ceiling

400% FPL (Family of 4)$128,600Common AGB cap ceiling

45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 78/100 · Corroborated CMS CCN 391318

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 391318) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage3/6/2026

Validated Rate Rows4,810 (CMS v3.0.0)

File Integrity DigestVerified · CCN 391318

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy